Chapter 6: Analysis and Discussion
6.2 Survey
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Table 3: Ability to control who can have access to EHRs Response Total General
public
Healthcare professionals
Healthcare Entities Management Employees
Yes 78 66 11 1
No 11 9 1 1
Unsure 16 11 4 1
As it is shown in Table 3, 78 "Yes" responses were collected, which represents a significant number to consider. Moreover, among these responses, 11 healthcare
professionals and one employee from healthcare entity management were there. 16 people were unsure about who could have access to their EHR. Four respondents were healthcare professionals, and one was a healthcare entity management employee. 11 of the total respondents did not want this type of control over EHR access.
From this table, we can identify the need that is imposed by healthcare
professionals and the general public, specifically to enable a patient to control access to what is considered private to them.
2) The question “How comfortable are you with the idea of other organizations (hospitals, research centers …) viewing your EHR?”
Table 4: Comfortable Viewing the EHRs Response Total General
public
Healthcare professionals
Healthcare Entities Management Employees
Uncomfortable 36 29 6 1
Neutral 34 25 8 1
Comfortable 31 29 1 1
Do not care 4 3 1 0
Table 4 shows that 6 of the respondents are uncomfortable with other entities viewing their EHR; 6 healthcare professionals and 1 healthcare entity management
53 employee. While 34 were neutral about it, 31 said they were comfortable, and 4 said they didn't care.
3) The question “Are you worried about data leakage and other users having unauthorized access to stored EHRs?”
Table 5: Unauthorized Access to the EHRs Response Total General
public
Healthcare professionals
Healthcare Entities Management Employees
Yes 48 42 6 0
Partially 41 32 8 1
No 16 12 2 2
In Table 5, it is clearly shown that 48 respondents were worried about data leakage and other users having unauthorized access to stored EHRs, with 6 healthcare professionals among these 48. On the other hand, 33 general public respondents and 8 healthcare professionals expressed their worries by selecting the partially option. This left us with 16 people who were unconcerned, including two healthcare professionals and two healthcare entity management employees.
4) The question “How safe and private do you believe EHRs are?”
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Table 6: EHRs Safety and Privacy Response Total General
public
Healthcare professionals
Healthcare Entities Management Employees
Unsafe 2 1 0 1
Questionable 25 23 0 2
Somewhat safe
33 25 8 0
Safe, but needs
improvement
36 29 6 1
Completely safe
9 8 0 1
Table 6 shows that 36 of the responses were "Safe, but needs improvement,"
with 6 healthcare professionals and 1 healthcare entity management employee among them, while 25 general public and 8 healthcare professionals chose "Somewhat safe." 25 people said "Questionable," including 23 members of the general public and one
healthcare entity management employee. Lastly, two options, "Completely safe" and
"Unsafe", received responses of 9 and 2, respectively, with no healthcare professionals as respondents.
5) The question “Do you think that sharing an EHR internationally should affect the kind of information being shared?”
55 Table 7: Type of Information Shared
Response Total General public
Healthcare professionals
Healthcare Entities Management Employees Yes, some data
should be redacted.
57 48 7 2
Yes, additional data should be added.
17 14 3 0
No 8 4 3 1
Don’t know 23 20 3 0
Table 7 clearly shows that "Yes, some data should be redacted" was checked by 57 of the respondents; 7 healthcare professionals and 2 healthcare entity management employees. In addition to the three healthcare professionals, 23 people said they didn't know, and 14 people said "Yes, more data should be added." Leaving us with 8
respondents for the answer "No".
6) The question “Are there measures in place, that you are aware of, to prevent unauthorized parties from accessing EHRs as they are being shared with another organization?”
Table 8: People's Awareness of Preventive Measures for EHRs Response Total General
public
Healthcare professionals
Healthcare Entities Management Employees
Yes 25 17 8 0
No 20 13 4 3
Don’t know
60 56 4 0
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As it is shown in Table 8, where three options; yes, no, and don't know were provided for the respondents, 60 didn’t know about the preventive measures taken for the sharing of the EHRs from unauthorized access, of which four healthcare
professionals were among these 60. 17 members of the general public and 8 healthcare professionals were aware of such preventive approaches. On the other hand, 20 people had no clue about such measures (there were 4 healthcare professionals and 3 healthcare entity management employees).
2. Blockchain Technology:
1) The question “If the use of Blockchains for EHR sharing will ensure security and privacy of EHRs sharing, will you encourage organization to use such a technology?”
Table 9: Encourage The use of Blockchain Response Total General
public
Healthcare professionals
Healthcare Entities Management Employees
Yes 93 80 12 1
No 12 6 4 2
93 out of the total respondents encourage the use of Blockchain for EHR sharing; including 12 healthcare professionals and 1 healthcare entity management employee) while 12 don’t encourage, as is clearly shown in Table 9.
2) The question “What benefits do you hope for from using Blockchains for EHRs sharing? (Please select all that apply.)”
57 Table 10: Detailed Benefits Gained Using Blockchain for EHRs Sharing
Response Total General Public
Healthcare Professionals
Healthcare Entities Management Employees Improved business
efficiency
49 43 6 0
Better transaction integrity and visibility
54 48 6 0
Increased transaction speed 46 42 4 0
Better data protection provided by Blockchain's ability to eliminate points of failure in business networks
65 55 10 0
Lower transaction cost 39 34 5 0
Stronger working
relationship with partners (via better collaboration, etc.)
44 36 8 0
Time savings (i.e.,
reducing time required for settling disputes, finding information, and verifying a transaction, leading to quicker settlement and deliveries, etc.)
53 45 8 0
Reduction of risks (i.e., by eliminating the risk of collusion, tampering, and unintentional leakage of information, etc.)
64 57 7 0
Don't know 15 7 5 3
Other 2 2 0 0
In Table 10, a detailed list of benefits gained using Blockchain for EHRs sharing is provided, specifying the number of responses gotten from the three categories of
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general public, healthcare professionals, and healthcare entity management employees.
"Better data protection provided by Blockchain's ability to eliminate points of failure in business networks" and the option "Reduction of risks" were chosen the most.
3) The question “What do you think the challenges which need to be addressed for a successful Blockchain implementation for EHRs sharing? (Please select all that apply.)”
Table 11: Detailed Blockchain Implementation Challenges for EHRs Sharing
Responses Total General public Healthcare professionals
Healthcare entities management
employees Blockchains are still
an emerging technology
54 49 5 0
Lack of understanding just what Blockchain can do/is good for
45 40 5 0
Lack of experts skilled in Blockchain technology
58 54 3 1
Lack of industry standards
46 43 3 0
Regulatory constraints 51 44 7 0
Privacy and security considerations
48 41 7 0
Don't know 20 11 7 2
other 4 4 0 0
In Table 11, a detailed list of Blockchain implementation challenges for EHRs sharing is provided, specifying the number of responses gotten from the three categories of the general public, healthcare professionals, and healthcare entity management
59 employees. In first place out of the seven possible options that a respondent can choose, the option "Lack of experts skilled in Blockchain technology" had 58 responses.
4) The question “Do you think that new regulations are needed to ensure controlled sharing of one’s EHR among parties even when Blockchains are used?”
Table 12: The Need for New EHRs Regulations Response Total General
public
Healthcare professionals
Healthcare Entities Management Employees
Yes 80 67 12 1
No 8 7 1 0
Don’t know
17 12 3 2
In Table 12, 80 (12 healthcare professionals and 1 healthcare entity management employee) of respondents agreed on having new regulations to control the EHR’s
sharing. 17 did not know if they needed regulations or not, and the healthcare
respondents were 12, in addition to one healthcare entity management employee. Which leaves us with eight that don’t think they need such regulation.
As seen in the survey analysis above, the majority of respondents are pleased with the idea of utilizing Blockchain to manage EHRs, indicating to the government that they are investing wisely. Tables 3,5, 6, 9, 10, and 12 show a greater need than the other tables for a Blockchain implementation with regulating policies to avoid any issues or challenges that may arise. Since this survey was completely anonymous, there might be a deviation in the transparency of the results. Moreover, the number of responses gathered is considered to be low, which may have an impact on the findings.
As for the proposed Blockchain-based policy, each healthcare entity should ensure that the measures for a successful implementation are provided, which will help in identifying the effectiveness of the policy and modifying it if needed on a continuous basis. The regulatory framework in which Blockchain technology is developed will have
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a significant impact on Blockchain development. There is a need for flexible and accessible approaches; the law must advance alongside technology.
3. SWOT
The need for establishing a Blockchain-based policy to manage the EHRs is highlighted by a SWOT analysis in Figure 14.
Figure 14: SWOT Analysis of the Need for a Blockchain-Based Policy to Manage EHRs
Earlier, a validity limitation was mentioned that could be overcome by the contextual indicators to measure that perception and provide the required data, which are organizational, technological, and environmental indicators.
1. Organizational factors
Factors that are related to the strengths and weaknesses of each healthcare entity. If an entity has these strengthening factors, they will affect it positively;
otherwise, they will negatively impact it as a weakness. The following are the factors for managing EHR through a Blockchain policy:
61 1.1 Perceived risks associated with early adoption and potential disruption to
existing industry practices
1.2 Increase the capability and skills of the healthcare entity.
2. Technological factors
Factors by which a technology is affordable an44d the healthcare entities' need to adopt Blockchain technology are listed below:
1.1 Interoperability, reliability, transparency, and auditability.
1.2 Information-sharing.
1.3 Maintaining data security and privacy.
1.4 Replaces centralized registries.
1.5 Transaction speed and scalability.
1.6 Improved transaction recordkeeping immutability.
1.7 Ensure that effective identification and authentication protocols are in place.
3. Environmental factors
Factors are subcategorized into politics, economics, and social. These factors, in contrast to organizational factors, cover the external factors that influence
Blockchain implementation, as shown below A. Political
1. Government leadership and vision
2. Establishing a Blockchain regulatory framework.
3. Establishing industry standards for security, privacy, and integrity 4. Legal and regulatory uncertainty
B. Economic
1. The high energy consumption of the technology (expensive).
C. Social
1. Trust and Privacy 2. Cybersecurity
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